Background The combination of cetuximab and radiation treatment can be a suitable option in elderly patients with head and neck cancer. However, survival benefit is lower in elderly patients, who can find it more toxic. Myelosuppression, diarrhoea, mucositis, nephrotoxicity and neurotoxicity have to be diagnosed promptly and treated appropriately.
Purpose To describe effectiveness and toxicity related to cetuximab combined with radiotherapy (RT) and assess potential factors affecting survival.
Materials and methods Retrospective observational study in patients not eligible for treatment with cisplatin due to their general condition.
Variables included: sex, age, ECOG, comorbidities, Charlson and WUHNCI indices, tumour localisation, stage and histology, number of cycles, delays, RT, toxicity and effectiveness. Statistical treatment: frequency, progression-free (PFS) and overall survival (OS) by Kaplan-Meier and factors related to them through univariate (log rank test) and multivariate (Cox regression) analysis. The Spearman rank correlation coefficient was used to compare the Charlson and WUHNCI indices. Significance from p ≤ 0.05.
Results 30 patients (25 men, 5 women) included, mean age 68.5 years (50–84), 56.7% had moderately differentiated and stage IVa cancers, 53.3% T4 and 40% N0. More frequent localisations: oral cavity (30%), larynx (30%) and oropharynx (23.3%).
Mean of comorbidities 3.6; median of 7 cycles; mean of Charlson and WUHNCI indices 2.8 and 2.0 respectively. Spearman’s rho correlation between the two indices was 0.76 (p < 0.001), suggesting high linear correlation.
88.5% received radical RT ≥70 Gy, 60–69 Gy 7.7% and <60 Gy the rest.
PFS and OS median were 14.8 and 19.3 months respectively.
In the multivariate analysis of OS adjusted for smoking, alcohol/tobacco habits, Charlson index and T stage, statistically significant independent variables were the T stage (p = 0.020, RR [relative risk] = 6.5) and the Charlson index (p = 0.022, RR = 6.9)
In patients with HNC not treatable with cisplatin due to their general condition, the association of cetuximab with radiotherapy provided a satisfactory response rate with tolerable toxicity.
Most common grade 3 toxicities were lymphopenia, asthenia, dysphagia, oromucositis, radiation dermatitis and acneiform rash, the latter two correlating positively with OS.
Comorbidity, assessed by Charlson index and T, tumour stage, had a significant negative correlation with OS.
No conflict of interest.
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